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Permit No. 2012-26488 T' Chino • City ofBUILDING DIVISION OF COMMUNITY DEVELOPMENTDEPARTM3 N Hills14000 City Center Or.,Chino Hills,CA91709 [ _ Counter Phone (909)364-2780 Building Permit 24-Hour Inspection Line (909)364-2790 _ (NOTE-You must call before 3p m.for a next business day inspection) City Hall Main Number (909)364-2600 Or NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. INSTALL ROOF MOUNTED PHOTOVOLTAIC SYSTEM 2012-26488 34124 BUILDING ADDRESS I APT./UNIT NO. I ISSUED DATE ISSUED BY 16261 VAN GOGH CT,Apt.0 0 10/23/2012 Heredia,Monica APN 101770336 ITRACT CCT MAP# I 079 LOT I FLOORS/UNITS I PROJECT PERMITS P.TYPE CENCUS CODES I CONST.TYPE I ZONING TYPE I OCCUPANCY TYPE 'VALUATION $32,000.00 I TOTAL SQFT 0001 BLDG.SQFT 434_Res Add/Alter -3 VS Current Owners: Fees Name:ISMAEL ILETO Fee Group/ Fee Description Fee Amount Payments Address. 16261 VAN GOGH CT CHINO HILLS CA 91709 Transaction Type Ph: 909-9833085 Photovoltaic System - $705.31 Email: M@CH.ORG Contractor REC SOLAR INC-REC SOLAR INC 6001 Permit Issuance Fee $54.00 54.00 Address: 775 FIERO LN#200 SAN LUIS OBISPO CA 8003 Residential Plan Check Fee $241,61 241.61 Ph. 805-528-9705 Email: WESPINOZA@RECSOLAR.COM 639-653 Residential Structural Fee _ $371.70 371.70 LJc.Intorfiatlon750184 Exp.Date:6130/2014 LICENSED CONTRACTORS DECLARAT1ONLICENSED CONTRACTORS DECLARATION 6103 Conduits/Conductors $3600 36.00 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing 561473 $2.00 2.00 with Sec.7000)of Dwision 3 of the Business and Professions Code,and my license is in full force and effect In secunng this permit I am acting with the knowledge of and on behalf of the owner of the property. TOTAL FEES $705.31 J '/ /0-'2-3 'I Z - '7A`a t--,.....:C9AMOUNT PAID $705.31 te: Contractor BALANCE DUE $0.00 OWNER-BUILDER DECLARATION I hereby affirm under penalty of penury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code, Any city or county which requires a permit to construct,alter,improve,demolish or repair any structure,pnor to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption. Any volation of Sec 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code' The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale, tt however,the building or improvement is sold within one year of completion,the owner-bidder will have the burden of proving that he she did not build or improve for the purpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor (s)licensed pursuant to the Contractors License Law). _I am exempt under article 3 of the Business and Professions Code. Date: Permitroe' Pnnt Full Name: WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations I have and will maintain a certificate of consent to self-insure for workers'compensation,as I certify that I have read this application and state that the above information is correct I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work forwhich this permit is with all city and county ordinances and state laws relating to building construction,and hereby authonze issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes 24 I have and willthe mperformance weofcompensationrwhithis permit as required My workerns oof the ""z/\/ ` Labor surae c fordr a d oliin mbar the work forwhich this permit is issued. My compensation insurance carrier and policy number are: / / v- 23•(T. 9 Carier.2-014J^ Ct1"«�• c4i^ Policy / PLICANT SIGNATURE DATE # W C c 7 a'S s+v u Applicant ALBERT MICHEL I certify that in the performance of the work forwhich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers compensation laws of California,and Address' 23052 ALCADE,SUITE C LAGUNA HILLS CA 92653 agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Ph- 949-091-0588 Email. M@CH.ORG ,Labor Code,I shall forthwith comply with those provisions. p,�3 .y.L _ Lic.Information Exp.Date: ( Date Applicant: AA.J.a—.T tS•t.a.X--._ I certify that the user of this facility shale comply with sections 25506,25533 and 25534 of the Health and Safety Code,which regulate the storage,handling and use of hazardous materials WARNING' Failure to secure workers compensation coverage is unlawful,and shall subject an employer to criminal penalities and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as provided for in section 3706 of the Labor Code,interest,and attorneys fees.